Marathoners: Prevent injuries

Over the past couple of months, a similar scenario has transpired in my clinic a number of times. An athlete comes in for an assessment and, during the history taking, I discover the athlete is training for a marathon or triathlon.

Usually, the athlete has come into the clinic because some sort of ache or pain has progressed to the point where it is affecting their performance or actually stopping them from training.

Of course, my next question is, “How long has this been going on?” To my surprise and dismay, when dealing with endurance athletes (athletes who run long distances or do triathlons), the answer to this question is often greater than three months and sometimes over a year!

When I ask why it has taken so long to address the pain, often the answer is, “Well… I just thought it would go away on its own.”

Often these athletes come into the clinic four to six weeks before their big event. Either the peak of their training regime has devastated their poor overused part, or they are starting to get worried about their weakest link and how it will react to race day stresses.

The problem is, often these types of injuries require rest in order to heal. That usually is not in the plan for an individual who is in the last month before a marathon.

As a therapist, this is a tough position to be in; these athletes have put in months of training every day, eating right, getting adequate rest, participating in 5am training sessions and staying in on the weekends. Now I have to tell them that they either have to rest, cross train or accept that they are going to run with a potential race-destroying injury.

Why did this happen and how can these athletes prevent this from occurring in the future?

Watch for warning signs

Most of these athletes have had some sort of warning sign for a significant period of time. Even though these individuals were still able to participate in their select training, they were all having pain, stiffness or tightness long before the actual injury forced them to take a break from training.

The lesson to be learned here is that it is important to listen to all the little messages your body is giving you. If you have pain, stiffness and tightness in your hamstring, for example, and you continue to train without addressing the issue, you will eventually strain the muscle. If you have sore shins just at the beginning of your training runs, if you continue to train and do not address it, it will become constant and even start to affect you when you are not training.

This does not mean you have to seek medical attention every time you have an ache or pain. If this were the case, all endurance athletes would constantly be seeking care.

However, if you have a muscle that is sore and tight, you should be paying special attention to that muscle. You should be doing proper warm-ups, stretching adequately and icing after activity. Give yourself one to two weeks to address the issue on your own and if you do not see any progress, then seek the advice of a professional physiotherapist or chiropractor.

Don’t wait until the last minute

Care certainly should not be left until the month of your major event because, at that point, options become limited.

Some other factors involved in the prevention of overuse injuries in the endurance athlete include:

The 500 mile rule – Running shoes are only good for 500 miles (800km). After that they are garbage. Personally, I write the date on my runners the first day I wear them. I know it takes me about three months to run 500 miles, so this helps me keep track of when to throw them in the bin.

Cross training is integral – If you are generally feeling achy in one specific joint or in many load bearing joints, get off your feet. Converting a workout to a water running workout or a spin bike workout means you can get the cardiovascular benefits without getting the impact on your joints.

Running surface – Running on concrete sidewalks and pavement is not easy on muscles and joints. Unfortunately, in Cayman, as there are not really many leisure trails. However, you do have other options to get off the hard pavement. Examples include, the golf course trails, the beach, treadmill running and soccer fields.

The 10 per cent rule – Never increase your weekly mileage or your long run mileage by greater than 10 per cent per week. For example, if you are training 50 miles a week and your long run is 10 miles, the most you should do the next week is 55 miles for the week and an 11 mile long run.

Recovery runs – If you do a hard training session with race pace intervals or tempo running, the next day must be a recovery run (easy running, shorter distances). Doing back-to-back ‘hard days’ is inviting injury. This becomes trickier with multi-event athletes, but the main message is, if you do too many hard days in a row, you are asking for trouble.

Rest and nutrition – It is important for all aspects of life. If you are having muscular or joint soreness the body needs energy and nutrients to heal. If you rehabbing from an injury getting over eight hours sleep per night and getting enough protein in your diet will give you the best chance at recovery.

Keep your mobility – Muscle and joint mobility is an important factor in a healthy athlete. Regular stretching (or warm muscles) is an important part of staying injury free. Yoga or chiropractic is a great way to stay as mobile as possible.

Address your aches and pains early – Address your achy parts immediately (independently and diligently try stretching after warm up and icing after work out). Seek guidance from a sports medicine doctor, physiotherapist or chiropractor if your overuse aches and pains last longer than one to two weeks, especially if they are progressively getting worse.

I am a competitive runner and I have not had to take more than three weeks off running in the past five years. This is because I take care of aches and pains before they become injuries!

So, with the Cayman Islands Marathon and the Cayman Islands Triathlon fast approaching, keep this message in mind. When it comes to your body, be proactive not reactive!

Krissy Dooling is a physiotherapist based in the Cayman Islands.

Packed crowds of runner make their way down Natio Parkway, Sunday 1 October, 2006 in the first few miles of the 26.3 mile race.